Take the challenge. M10.072—Acute gout has an Excludes 1 note of chronic gout (M1A.-). This means that acute gout and chronic gout cannot be coded for the same encounter, as the codes are mutually exclusive. M45.6—The patient is diagnosed with ankylosing spondylitis of the lumbar region. M81.8—Other osteoporosis without current pathological fracture. M79.622—The patient has…
Rheumatologist Rudy Molina, MD, Pursues Passion for Paleontology
When Rodolfo “Rudy” Molina, MD, was 8 years old, a college recruiter visited his home. Unbeknownst to his parents, their son, now a rheumatologist at Arthritis Associates in San Antonio, Texas, had entered several of his drawings in a competition intended for high school students. The recruiter, unaware of the young artist’s age, was definitely…
When to Claim Social Security
As a Certified Financial Planner, I run a practice specializing in guiding families to and through retirement. A question we almost always hear is, “When should I take my Social Security?” The best answer to that question often depends on the client’s personal situation, but clients are often unaware of three common scenarios that may…
Case Report: Sternoclavicular Erosions in a Patient with Uncontrolled RA
Sternoclavicular joint involvement has rarely been reported in the context of active rheumatoid arthritis (RA).1 Traditionally, rheumatologists use serial radiographs of hands and feet to diagnose, monitor for progression or evaluate the response to treatment. The sternoclavicular (SC) joint is not a typical joint assessed for RA. However, the fact that it is a diarthrodial…
New President Dr. Von Feldt Looks at Where ACR Is Headed in 2016
I am honored, humbled and excited to serve as your ACR president. I’d like to share the following background information to illustrate the diverse set of life experiences I draw from to represent the ACR membership effectively. Personal Background Thanks to my mom, who was born and raised in Guatemala, I am bilingual in Spanish…
Air Pollution: Is There an Association with Rheumatic Disease?
Interactions between an individual’s genetic background and their exposure to environmental factors are thought to result in a cascade of immune reactions, ultimately leading to the development of autoimmune diseases such as rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), systemic lupus erythematosus (SLE) and juvenile dermatomyositis.1,2 For example, an environmental factor that conclusively affects susceptibility…
Best Practices for Treating Non-Specific Low Back Pain
Low back pain (LBP) is one of the most common reasons for physician appointments. However, treatment results remain suboptimal, resulting in high rates of chronic pain, narcotic usage, surgery, depression and disability—all at great cost to individuals and the nation. One reason for this is the current practice of grouping all low back pain patients…
Looking Back on Rheumatology in 2015, Leaping Forward to the Year Ahead
My dear friends, we come to praise Caesar. As we march toward 2016, we ought to acknowledge the great Roman emperor’s role in creating a proper calendar. At the start of Caesar’s reign, the calendar year lasted 355 days, 10¼ days fewer than the time it took the earth to fully orbit the sun.1 Although…
Clues to Diagnosing, Managing Vanishing Aneurysms
Case report: A 27-year-old male was referred to the rheumatology outpatient department in February 2015 from the urology department after complaining of recent-onset uncontrolled hypertension (220/160 mmHg), headache and vomiting. In 2010, he was admitted to the urologist for sudden-onset left lumbar region pain and recent-onset hypertension. Clinical examination and the blood tests were normal….
How to Manage Polymyalgia Rheumatica
Recognizing the need to provide guidance on the current disparate management of polymyalgia rheumatica (PMR), the American College of Rheumatology (ACR), in collaboration with the European League Against Rheumatism (EULAR), recently published the first international set of recommendations for the screening, treatment and management of PMR.1,2 Specifically, the recommendations offer guidance on the use of…
GPA Patient Carries NORD Banner to Top of Mt. Everest
On May 23, 2010, Cindy Abbott was standing on top of the world. She had spent the past 51 days climbing Mount Everest, the tallest mountain in the world, and had finally reached the summit. “I was very anxious to get off and get back down,” she says, adding that the summit is about the…
Rheumatologists Remember Dr. Engleman, Pioneer, Leader, ‘Full Human Being’
Two years ago, at the age of 102, rheumatologist Ephraim P. Engleman, MD, FACR, FACP, published a memoir, My Century, in which he detailed his personal and professional accomplishments, as well as his secrets to longevity. With his characteristic sense of humor, Dr. Engleman noted that the first secret to a long life is to…
A Brief History of American Rheumatology
In medicine, as in all other areas of human endeavor, we cannot really understand where we are if we don’t understand how we arrived here. American rheumatology traces its origins nine decades back to Europe, when the International Committee on Rheumatism was founded by Jan van Breeman in 1925 at a European meeting of medical…
How to Keep Patient Appointments Running on Time
Nobody likes waiting to see their physician. In fact, a whopping 97% of patients are frustrated by wait times at the doctor’s office, a study has reported.1 That’s a lot of unhappy patients. Fortunately, a practice can do many things to help keep patient appointments on time—beginning with proper scheduling techniques and monitoring patients’ progress…
Patient-Centered Care Model for RA Flares Could Improve Self-Management of Symptoms
A recent trend to incorporate patient-reported outcomes (PROs) in clinical research, and ultimately clinical practice, is a response to the need to better measure and treat what patients truly care about, and adapt to the changing healthcare environment, which increasingly includes patient satisfaction as a key metric for overall quality of care, a metric tied…
Cyber Risks: A New Area of Liability for Medical Practices
Computerization of healthcare in general, and medical records in particular, has opened additional areas of liability for medical practices that many may not be addressing. A data breach of patient records can have major financial and business impacts on the practice when they occur. Data Intrusions Increasing The number of data intrusions hit a record…
The ACR/ARHP Awards Members for Contributions to Rheumatology
San Francisco is known for the Gold Rush, so it’s a particularly fitting place to collect a gold nugget. And so at the 2015 ACR/ARHP Annual Meeting in the Golden Gate City in November, the ACR and the ARHP honored a group of distinguished individuals who have made significant contributions to rheumatology research, education and…
Dr. Smith Finds Commonalities in Chess, Rheumatology: Think Ahead, Know Your Patient
James K. Smith, MD, believes in thinking several moves ahead. Consider your opponent. Gauge your strategy. Be aggressive when you need to be. Those are key aspects of his philosophy in rheumatology—and chess. Initiation Dr. Smith’s love of chess started after he had started his family. “I first got involved in the game through my…
Understanding the Z Codes in ICD-10
Two months into the transition, the ICD-10 code set is still not exactly the most enticing reading material. But there is still so much to learn and apply, that it is necessary for physicians, coders and billers to stay abreast of the coding and billing guidelines. Although all of the guidelines and conventions may be…
Tips for Educating Patients in the Age of Biologics
Patient education has always been at the core of the nursing profession. Nurses pride themselves on being great teachers and patient advocates. When self-injectable biologics were first introduced to the market, one of the main goals was to make patients independent and put them in the driver’s seat of their own care. Yet without a…
Rheumatology Research Foundation’s Partnership with CRT Allows for Investment in Research, Training
The Rheumatology Research Foundation has infused more than $130 million into rheumatology research, education and training since it was established in 1985. The Foundation’s efforts have been greatly enhanced by the support of Corporate Roundtable (CRT) members. The CRT is a dynamic partnership between the Foundation and members of the pharmaceutical industry committed to furthering…
Rheumatology Research Foundation’s Incoming President Shares Vision for Building the Next 30 Years of Growth
Meet the Foundation’s incoming president, Eric L. Matteson, MD, MPH. Dr. Matteson trained in rheumatology at the University of Michigan and Mayo Graduate School of Medicine, Mayo Clinic College of Medicine. He later earned his Master of Public Health in epidemiology at the University of North Carolina, Chapel Hill. Dr. Matteson currently works as the…
Educating Medical Students on Rheumatology Early May Help Recruitment
As usual, your items in The Rheumatologist remain timely. In the case of attracting medical students into rheumatology, your piece is also timeless. For many years now, I have recommended to various officers of the ACR that we obtain a list of students and their home addresses when they are admitted to medical school. At…
Why Rheumatology May Be an Attractive Specialty for Medical Students
I want to thank you for writing the article, “Attracting More Medical Students to Rheumatology” for The Rheumatologist (online, October 2015). I am a senior at Georgetown University now, and I have recently applied to medical school. I have considered pursuing a career in rheumatology, and your article has inspired me to stay on that…
Rheumatology Coding Corner Question: Coding for Acute Flare of Idiopathic Gout
It has been two months since the implementation of ICD-10, so everyone has gotten a feel for the new code set. Let’s see how well you are doing in your diagnosis coding for rheumatology-specific conditions. A 55-year-old female patient presents for a follow-up visit of idiopathic chronic gout of multiple joints without tophi. She complains…